Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Today’s Veterinary Practice March/April 201236
Challenges & New Developments in
Canine PyodermaTopical & Systemic TreatmentKimberly S. Coyner, DVM, Diplomate ACVD
This is the second article in
a 3-part series discussing the
latest information available
regarding canine pyoderma.
The first article, Challenges &
New Developments in Canine
Pyoderma: Disease Overview
& Diagnosis, can be found at
todaysveterinarypractice.com
under Article Lists.
Peer reviewed
As discussed in
Part 1 of this series
(Disease Overview &
Diagnosis), canine pyoderma can be
classified by depth of infection as:
•Superficialorsurfacepyoderma
•Deeppyoderma.
Treatment decisions for canine recurrent pyoderma include
consideration of the:
•Distributionoflesions(localizedversusgeneralized)
•Underlyingcauseofrecurrentinfections.
TREATMENT OPTIONS
Theclassificationsabovehelpdeterminethetreatmentregi-
men for each case of pyoderma:
•Very superficial or localized cases of canine pyoderma
may be treated with topical antibacterial medications
alone (Table 1,page38).
•Generalized or deep cases are usually best treated with
a combination of oral antibiotics and topical antibacterial
therapies (Table 2,page40).
•In very pruritic patients, a short (1–2 week) course of
oral anti-inflammatory doses of prednisone may be helpful;
however, antibiotics should always be continued beyond
steroid discontinuation. Long-acting, injectable steroids
should never be used in cases of canine pyoderma, as
theywillmakehealingdifficult to assess, impair immune
responsetoinfection,andpotentiallyhaveaharmfuleffect
onthehypothalamic–pituitary–adrenal(HPA)axis.
March/April 2012 Today’s Veterinary Practice 37
CANINE PYODERMA: TOPICAl & SYSTEMIC TREATMENT |
Other Therapy
Vetericyn All Animal Wound and Infection Treatment
(vetericyn.com), an oxychlorine compound, has had
anecdotal success and safety in the treatment of canine
pyoderma.See todaysveterinarypractice.com/resourc-
es.asp to view and download a comprehensive table
outliningTopical Antibacterial Products.
SYSTEMIC ANTIMICROBIAL THERAPY
Systemic antibiotics are used for bacterial skin infec-
tions that may not be treatable with topical therapies
alone.Antibioticchoiceforaparticularcaseisdepen-
dentonmultiplefactors,including:
•Depthofinfection
•Cultureandsensitivityresults(ifapplicable)
•Potentialdrugsideeffects(ie,avoidingcephalexin-
induced gastrointestinal adverse effects in a dog
withahistoricallysensitivestomachorsulfadrugs
in a dog with pre-existing dry eye or keratocon-
junctivitissicca)
•Age-orbreed-relatedpredispositionforsideeffects
•Drugcost
•Frequency of administration, which affects client
compliance.2
Antibiotic Action
Antibiotics are either time dependent or concentration
dependentintheiraction.
Figure 2. Cutaneous atrophy and tearing
secondary to chronic administration of a spray
containing triamcinolone
Figure 1. Cutaneous atrophy and milia formation
secondary to chronic topical administration of a
spray containing betamethasone
•In recurrent cases of canine pyoderma it is essential
to identifyandtreat theunderlyingcause.Depending
onclinicalpresentation,ageofonset,seasonality,and
otherclinicalsigns,thismayinclude:
» Stringentfleacontrol
» DeepscrapingsforDemodex
» Trial treatment for scabies
» Hypoallergenicdiettrial
» Intradermalallergytestinganddesensitization
» Laboratoryanalysistoidentifyendocrinopathies
» Skinbiopsyforkeratinizationdisorders.
TOPICAL THERAPY
Localized or Superficial Infection
For localizedareasof infection, topicalantimicrobialoint-
mentsorcreamscontaining2%mupirocinorsilversulfadia-
zineappliedtwicedailycanbeveryhelpful.
•Althoughhelpfulinsomecasesforshort-termtherapy,
sprays and ointments that contain combinations of
steroids and antibiotics are NOT recommended for
long-termusedue to potential for cutaneous atrophy
(Figures 1 and 2).
•Neomycinhasmorepotential forallergicsensitization
compared to other topical antibiotics, and susceptibility
isvariableforgram-negativeorganisms.
•Polymyxin B and bacitracin in combination may be
effective for both gram-negative and gram-positive
organisms; however, they are rapidly inactivated by
organic debris, including pus, and do not penetrate
well.1
Generalized or Deep Infection
Unlessskininfectionisverymildorshampootherapyisdone
every1to2days,topicaltherapyaloneisunlikelytoresolve
amoregeneralizedorseverepyoderma,butitcanbevery
helpfulinabbreviatinginfectionwhenusedincombination
withsystemicantibiotics.
•Most cliniciansprefer chlorhexidineproducts as first-
linetherapy.
•Antibacterialshampoosneedcontactwiththeskinfor5
to15minutestoprovidethedesiredtherapeuticeffect
(label recommendations should be followed and clients
shouldreceivespecificinstructionsonuse).
•In dogs with deep pyoderma or heavily crusted
lesions,clippingoflesionsorwhirlpooltherapymay
bebeneficial.
Shampoo Therapy
Shampoofrequencydependsonseverityofinfection:
•In severe cases or in cases of methicillin-resistant
pyoderma,shampootherapyevery1to2daysisrec-
ommended.
•In milder pyoderma cases, twice weekly shampoo
therapymaybesufficient.
•For maintenance prophylactic therapy, minimum
once weekly antibacterial shampoo therapy is recom-
mended; leave-on antibacterial conditioners are also
veryhelpful.
| CANINE PYODERMA: TOPICAl & SYSTEMIC TREATMENT
Today’s Veterinary Practice March/April 201238
Table 1: Canine Superficial or Surface Pyoderma: Clinical Signs & Treatment
Pyoderma Clinical Signs Treatment
SuRfACE PYODERMA
Impetigo • Nonpruriticpustulesnotassociatedwith
follicles• Onsparselyhairedareasoftheskin,such
as inguinal area• Pustuleresultsinepidermalcollarettesand
scaling• Oftenseeninyoungpuppies1,2
• Applytopicalantibacterialtherapy(ie,
chlorhexidine)
• Rarely,refractorylesionsmayrequireoral
antibiotics for 10 to 14 days1
Intertrigo
(fold Dermatitis/
Pyoderma)
(Figure 3)
• Dermatitisoccursinareasofskinfolding,
suchasface,lip,andtailfoldsandvulvar
area• Lesionsareareasofmoist,inflammatory
dermatitiswithsurfacebacterial
overgrowth1,2
• Cleanseareaevery1to3dayswith
antibacterialwipe,flush,orshampoo
• Applytopicalantibioticcreamorsolution
daily for 5 to 7 days• Refractorycasesmayrequiresurgical
excisionofexcessivefolds2
Mucocutaneous
Pyoderma
(Figures 4–6)
• Dermatitisoccursonlipmargins,eyelids,
nares,oranus2
• Erythema,inflammation,andcrusting+/-
depigmentation
• Applytopicalantibacterialtherapy(ie,
mupirocinQ12Hfor14days)
• Forseverecases,systemicantibiotics
shouldbeadministeredfor3to4weeks2
Pyotraumatic
Dermatitis
(Acute Moist
Dermatitis)
(Figure 7)
• Areasofacute,painful,moist,exudative,
inflammatory dermatitis created by self trauma• Oftenoccursinthick-coateddogswith
underlying flea allergy or atopic dermatitis• Peripheralpapules/pustulesorthickened
lesions indicate pyotraumatic folliculitis1,2
• Mayneedsedationtoclip/clean
• Followwitha1-to2-weekcourseoforal
steroidandtopicalastringents/antibacterial
products+/-topicalsteroidsorpramoxine;
avoidproductscontainingalcohol
• Ifperipheralpapules/pustulesnotedor
lesionisthickened,a2-to4-weekcourse
of systemic antibiotics is indicated.1
SuPERfICIAL PYODERMA
Bacterial
folliculitis
(Figures 8–10)
• Primarylesions:Papules(1–2mmraised
and/orcrusted,pinkorredbumps)and
pustules • Secondarylesions:Expandingareasof
alopecia;surroundingscaling(epidermal
collarettes),crusts,hyperpigmentation,and
lichenification1,2
• Applyantibacterialshampoos,conditioners,
and/orsprays
• Administer3-weekminimumcourseof
systemic antibiotics1
Bacterial
Overgrowth
Syndrome
(Figure 11)
• Erythema,scaling,lichenification,
hyperpigmentation,odor,pruritus,and
eventualalopecia
• Oftenpresentonventraltrunk,axillary,and
inguinal areas• Nopapules,pustules,orepidermal
collarettes present3
• Applyantibacterialshampoos,conditioners,
and/orsprays
• Administer3-weekminimumcourseof
systemic antibiotics3
Note: All oral antibiotic treatment should be continued 1 to 2 weeks past clinical resolution; a recheck visit is needed prior to discontinuation of therapy.
References
1. Scott dw, miller wH, Griffin Ce. Muller and Kirk’s Small Animal Dermatology, 6th ed. Philadelphia: wB Saunders, 2001, pp 291-296.2. medleau L, Hnilica Ka. Small Animal Dermatology: A Color Atlas and Therapeutic Guide. Philadelphia: wB Saunders, 2001.3. Pin d, Carlotti dn, Jasmin P, et al. Prospective study of bacterial overgrowth syndrome in eight dogs. Vet Rec 2006; 158:437-441.
•Time-dependent antibiotics must be given at
theirspecifieddosingintervalformaximaleffica-
cy,asthedurationoftimethattheantibioticlevel
remainsabovetheminimuminhibitoryconcentra-
tion(MIC)isessential.Theseantibioticsinclude:
» Cephalosporins
» Beta–lactam-resistantpenicillins
» Macrolides
» Lincosamides.
•Concentration-dependent antibiotics include
fluoroquinolonesandaminoglycosides.Withthese
drugs, the rate and extent of the bacterial killing
increasesastheantibioticconcentrationincreases.
Thepeakserumconcentration,notthetimeabove
MIC, is correlated with treatment efficacy; the
drugsarebestgivenatahigherdoseoncedaily.2,3
March/April 2012 Today’s Veterinary Practice 39
CANINE PYODERMA: TOPICAl & SYSTEMIC TREATMENT |
Antibiotic Selection
When choosing empiric antibiotics, it is first important
to avoid antibiotics to which staphylococcal bacteria
are usually intrinsically resistant, including amoxicillin,
ampicillin, penicillin, tetracycline, and nonpotentiated
sulfonamides.
•Antibiotic classesthatareusuallyeffectiveforcanine
pyoderma include:
» Cephalosporins
» Macrolides
» Lincosamides
» Potentiated sulfonamides
» Beta–lactamase-resistantpenicillins
» Fluoroquinolones
» Aminoglycosides
» Chloramphenicol.2
•For first-line therapy for canine pyoderma, most
veterinarydermatologistsuse:
» Cephalosporins
» Clavulatedpenicillin
» Potentiatedsulfonamides.
•For second-line therapy for deep, fibrotic infections
and/or Pseudomonas infections and when no other
reasonableantibioticchoicesareavailable,fluoroqui-
nolones are used when indicated by culture and sen-
sitivity. Veterinary-labeled fluoroquinolones (which
havenearcompletebioavailability4)arepreferredover
genericciprofloxacinduetomarkedvariabilityofcip-
rofloxacinabsorptionindogs.5
•Inonestudy,theoralabsorptionofgenericciprofloxa-
cintabletsindogsrangedfrom98%to29%andeven
atahighoraldoseof20to30mg/kg,thearea-under-
the-curve(AUC)didnotattainahighenoughlevelfor
bacteria considered “susceptible.” Thismay result in
therapeutic failure and increased selection of resistant
bacteria,particularlywhenlowdosesareused.5
Figure 3. Facefold intertrigo Figure 4. Mucocutaneous pyoderma Figure 5. Nasal mucocutaneous
pyoderma secondary to atopy
Figure 6. The same dog in Figure 9 after 3 weeks of oral and topical antibiotic therapy
Figure 7. Pyotraumatic folliculitis
secondary to atopy
Figure 8. Papules and pustules in an
atopic dog
Figure 10. Superficial pyoderma in a
hypothyroid dog
Figure 9. Epidermal collarettes in an
atopic dog
Figure 11. Bacterial overgrowth
secondary to atopy
| CANINE PYODERMA: TOPICAl & SYSTEMIC TREATMENT
Today’s Veterinary Practice March/April 201240
Table2.DeepPyoderma:ClinicalSigns&Treatment
Deep Pyoderma Clinical Signs Treatment
Acral Lick
Dermatitis(Figure 12)
• Alopecic,firm,raised,thickenedplaqueornodulethatmay
becomeulcerated
• Oftenfoundonthedorsalcarpusordorsolateralmetatarsus
• Multifactorial,self-inflicted(bylicking)disorderoftenassociated
withunderlyingatopicdermatitis,foodallergy,trauma,
endocrinopathy,bonepain,neuropathy,orbehavioralcauses
• Perpetuatedbysecondarydeeppyoderma1,2
• Administer8-weekminimumcourseof
systemicantibiotics
• PreventlickingwithElizabethancollaror
bandaging
• Identifyandtreatunderlyingcause(s)1,2
Bacterial
furunculosis(Figure 13)
• Focaltomultifocalareasofthickcrusting,alopecia,inflamed
bullae,and/orulcerativedrainingskinlesions,oftenpruriticand/or
painful
• Oftenassociatedwithunderlyingatopicdermatitis,foodallergy,
endocrinopathy,demodicosis,etc1,2
• Administer6-to12-weekcourseofsystemic
antibiotics
• Applyantibacterialshampoos/sprays
frequently
• Identifyandaddressunderlyingcause(s)1,2
Callus
furunculosis
• Inflammation,swelling,ulceration,anddrainingtractsaffecting
pressurepoints,suchaslateralelbows/hocksorsternalcallous
indeep-chestedbreeds
• Mostcommonlyaffectsgiantbreeds1,2
• TreatinfectionwithmupirocinQ12Hand
6-weekminimumcourseofsystemicantibiotics
• Usehydrotherapy(seePhysical
Rehabilitation for Veterinary Practices,
page14)andbandagingforopenlesions
• Ensuredoglaysonpaddedbeddingorhas
paddeddressingsplacedoverwound(ie,
DogLeggs,dogleggs.com)1,2
Canine Acne(Figure 14)
• Nonpainful/nonpruriticpapules,pustules,bullae+/-drainingtracts
onthechinormuzzle
• Morecommoninlarge,young,short-coateddogs
• Maybeinducedbyfrictionortraumatothechin,whichpushes
theshorthairsundertheskin1,2
• AdministermupirocinQ12Horbenzoyl
peroxidegelQ24Huntillesionsresolve;
then1to2timesweeklyasneededfor
maintenance
• Forseverecases,administera4-week
minimumcourseofsystemicantibiotics1,2
Pedal
folliculitis/
furunculosis(Figures 15
and 16)
• Interdigitalerythema,pustules,bullae,nodules,fistulas,alopecia,
andswelling;variablypainfulandpruritic
• Oftenseeninlarge,short-coateddogs
• Maybeassociatedwithregionallymphadenopathyand/orswelling
ofassociatedmetacarpusormetatarsus
• Oftenassociatedwithunderlyingatopicdermatitis,foodallergy,
endocrinopathy,demodicosis,etc1,2
• Insomecasesisolatedlesionsareassociatedwithabnormal
weightbearingandformationofinterdigitalcysts,oftenbetween
P4andP53
• Administer6-to12-weekcourseofsystemic
antibiotics
• Applyantibacterialshampoos/sprays
frequently
• Identifyandaddressunderlyingcause(s)
• Focalareasofscarring/interdigitalcyst
formationmaybeamenabletosurgical
resectionorlaserablation1,3
Post-
Grooming
furunculosis(Figure 17)
• Usuallyoccurswithin24to48Haftergrooming
• Areasofintenselocalizederythemaandswellingthatevolveinto
punctuatefocioferythema,erosion,painfulhemorrhagicbullae,
anddrainage
• Lesionsareusuallyonthedorsaltrunkandoccurmorecommonly
inshort-coateddogs.Affecteddogsmaybelethargicorfebrile.
• Staphylococcuspseudintermedius,Pseudomonas,Proteus,and
Escherichiacolihavebeengrowninpureormixedculturefrom
lesions.
• Causalfactorsincludecontaminatedshampoosorgroomingappa-
ratusandover-zealousscrubbingofshorthairs“againstthegrain”4,5
• Obtainswaborbiopsyforculture/sensitivity
and,pendingcultureresults,usecytologyto
determineinitialsystemicantibiotictherapy:
» Fluoroquinoloneifrodbacteriaarefound
» Cephalosporinifcocciarefound
• Sedationusuallyneededforclippingand
cleaningoflesions
• Paincontrolwithopioidsmaybeneeded
+/-IVfluidsandsupportivecareforseverely
affectedorsystemicallyilldogs5
Notes: • In deep pyoderma, all oral antibiotic treatment should be continued 2 to 3 weeks past clinical resolution; a recheck
visit is needed prior to discontinuation of therapy. • Ideally, antibiotic selection should always be based on culture and sensitivity for any case of deep pyoderma.
References
1. Scott DW, Miller WH, Griffin CE. Muller and Kirk’s Small Animal Dermatology, 6th ed. Philadelphia: WB Saunders, 2001, pp 291-296.
2. Medleau L, Hnilica KA. Small Animal Dermatology: A Color Atlas and Therapeutic Guide. Philadelphia: WB Saunders, 2001.
3. Duclos DD, Hargis AM, Hanley PW. Pathogenesis of canine interdigital palmar and plantar comedones and follicular cysts, and their response to laser surgery. Vet Derm 2008; 19(3):134-141.
4. Gross TL, Ihrke PJ, Walder EJ, Affolter VK. Skin Diseases of the Dog and Cat, Clinical and Histopathologic Diagnosis, 2nd ed. Oxford: Blackwell Science Ltd, 2005, pp 427-429.
5. Hillier A, Alcorn JR, Cole LK, et al. Pyoderma due to Pseudomonas aeruginosa in dogs: 15 cases. Proc AAVD/ACVD Meeting, 2003, p 222.
March/April 2012 Today’s Veterinary Practice 41
CANINE PYODERMA: TOPICAl & SYSTEMIC TREATMENT |
•Duetosideeffectsandtoxicitypotential,aminogly-
cosides and chloramphenicol are only used, based
onculture/sensitivitydata,asalastresortandwith
careful laboratorymonitoring incasesofmethicil-
lin-resistantinfections.
Antibiotic Administration
After an antibiotic has been selected, it should be dis-
pensedatthecorrectdosage,administeredatthecor-
rectdosing interval,andused forasufficientperiod.1
Underdosinganantibioticduetoclientconcernsabout
costwillonlybemoreexpensiveinthelongrundueto
increased time to cure and increased chance of induc-
ing bacterial resistance, necessitatingmore expenses,
suchasculturesandadditionalantibioticcourses.
Thedurationofantibiotictherapydependsonseveral
factors,includingdepthofpyoderma,underlyingdis-
eases,anduseofconcomitanttopicaltherapies.
•Ingeneral,superficialpyodermasusuallyresolve
with a 3-week course of an antimicrobial; treat-
ment should continue 1 to 2 weeks beyond heal-
ing/resolutionofcutaneouslesions.
•For deep pyoderma, a 6- to 12-week course of
treatment(3weeksbeyondresolutionofcutane-
ous lesions) or even longermay be required to
resolvedeeppocketsofinfection.1
•Regular rechecks are important to determine
response to therapy and need for medication
refillsortherapymodifications.
See todaysveterinarypractice.com/resources.
asp to viewanddownloada comprehen-
sive table outlining Commonly Used
Antibiotics for Canine Pyoderma.
IMMuNOSTIMuLANTS
When an underlying cause cannot be
found in cases of canine recurrent pyo-
derma, use of immunostimulants may be
of benefit. Two commercial bacterins are
currentlyavailable.
Staphage Lysate
Staphage lysate (SPL, delmont.com) is
derived from lysed-killed S aureus and is
given subcutaneously. In one study of 21
dogs with idiopathic superficial recurrent
pyoderma treated with either bacterin or
placebo (and an initial 6-week course of
oralantibiotics),dogsgivenantibioticsplus
the bacterin (n = 13) had a significantly
betterresponseafter18weeksoftreatment
thanthosegivenantibioticplusplacebo.9
Although there is no published sup-
portivedata, staphage lysatemay alsobe
helpful as adjunctive therapy in atopic
dogs that continue to develop recurrent
pyoderma despite appropriate manage-
mentoftheiratopicdermatitis.
ImmunoRegulin
ImmunoRegulin (neogen.com) is an
immunostimulant derived from killed
Propionibacterium acnes and adminis-
tered IV. Inonestudy,dogswithchronic
recurrent pyoderma were treated with anti-
bioticsplusIVinjectionsofeitherP acnes
or placebo. Eighty percent (12/15) of the
dogs treatedwithantibioticsandP acnes
respondedwithsignificantimprovementor
complete remission of lesions at the end of
the 12-week treatment schedule compared
with 38% (5/13) of the dogs treatedwith
antibioticsandplacebo.10
Figure 14. Canine acne in a pug Figure 15. Pedal furunculosis
secondary to atopy
Figure 16. Deep pyoderma
secondary to Demodex
Figure 17. Post-grooming
furunculosis
Figure 12. Acral granuloma
secondary to atopy
Figure 13. Deep pyoderma
secondary to atopy
| CANINE PYODERMA: TOPICAl & SYSTEMIC TREATMENT
Today’s Veterinary Practice March/April 201242
Other Immunostimulants
A more recent, blinded study of an
autogenousS intermedius (pseud-
intermedius) bacterin (prepared
by culturing the individual dog’s
pyoderma lesions) compared the
bacterinversusplaceboin10dogs
with idiopathic recurrent pyoder-
ma; all were initially treated with
a4-weekcourseoforalantibiotics.
After5weeks,clinicalscoreswere
notsignificantlydifferentbetween
groups; however, at week 10, the
placebo treated group had statis-
tically higher lesion scores com-
pared to the treatment group.11
Unfortunately, this product is not
commerciallyavailable.
Finally,genomesequencingtech-
nologyandproteomicapproaches
to identify surface-exposed staphy-
lococcal bacterial proteins may
lead to development of vaccines
to induce protective immunity;
the entire genome sequence of S
pseudintermedius has recently
been determined, and this may lead
tonewandeffectiveapproachesfor
the prevention and treatment of
caninepyoderma.12 ■
FLUOROQUINOLONES:
USE wIth CaUtIONUseoffluoroquinolones
shouldbecarefullyassessed
inviewofassociationsfound
between:
• Fluoroquinoloneuseinhos-
pitalsandmethicillinresis-
tance in S aureus
• Fluoroquinoloneuseincom-
munitiesandfluoroquinolone
resistance in Escherichia coli inhospitals.6 Additionally,studieshave
foundthat,althoughfluoro-
quinolonesmaynotactas
primary mutators for induc-tionofmethicillin-resistantS
aureus(MRSA)resistance,
whentheyareusedincases
ofheteroresistantMRSA,
theycanselectforhigh-level
methicillinresistantmutants
(whicharenotonlyresistant
tofluoroquinolonesbutalsoto
mostotherantibiotics).7,8
NADA # 141-266. Approved by FDA.
POSATEX® OTIC SUSPENSION(ORBIFLOXACIN, MOMETASONE FUROATE MONOHYDRATE AND POSACONAZOLE, SUSPENSION)ANTIBACTERIAL, ANTI-INFLAMMATORY, ANTIFUNGAL
For Otic Use in Dogs Only
BRIEF SUMMARY (For full Prescribing Information, see package insert)
CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian.
Federal law prohibits the extralabel use of this drug in food-producing animals.
INDICATIONS POSATEX® OTIC SUSPENSION is indicated for the treatment
of otitis externa in dogs associated with susceptible strains of
yeast (Malassezia pachydermatis) and bacteria (coagulase
positive staphylococci, Pseudomonas aeruginosa, and
Enterococcus faecalis).
CONTRAINDICATIONSPOSATEX® Otic Suspension is contraindicated in dogs
with known or suspected hypersensitivity to quinolones,
mometasone furoate monohydrate, or posaconazole.
Do not use in dogs with known tympanic perforation
(see PRECAUTIONS).
PRECAUTIONSThe use of POSATEX® Otic Suspension in dogs with
perforated tympanic membranes has not been evalu-
ated. The integrity of the tympanic membranes should be
confi rmed before administering this product.
Avoid prolonged or repeated use of POSATEX® Otic
Suspension. Long-term use of topical otic corticosteroids
has been associated with adrenocortical suppression and
iatrogenic hyperadrenocorticism in dogs (see ANIMAL
WARNINGS).
The safe use of POSATEX® Otic Suspension in dogs used
for breeding purposes, during pregnancy or in lactating
bitches, has not been evaluated. The systemic administra-
tion of quinolones has been shown to produce cartilage
erosions of weight bearing joints and other signs of
arthropathy in immature animals of various species.
WARNINGS:Human Warnings: Not for use in humans. Keep out of
reach of children.
Animal Warnings: Do not administer orally. Immediately
discontinue use of POSATEX® Otic Suspension if hear-
ing loss is observed during treatment (see ADVERSE
REACTIONS).
ADVERSE REACTIONSIn the fi eld study, 143 dogs were treated with POSATEX®
Otic Suspension. Of those, 1 dog with bilateral otitis externa
developed transient hearing loss.
POSATEX® Otic Suspension treatment was discontinued
and the condition resolved after one week.
HOW SUPPLIEDPOSATEX® Otic Suspension is available in 7.5 g, 15 g, and
30 g plastic bottles.
Made in Germany
Intervet/Schering-Plough Animal Health.© 2009 Intervet Inc., Roseland, NJ 07068.All rights reserved. 01/10
The final article in this series will focus specifically on
methicillin-resistant canine pyoderma.
HPA=hypothalamic–pituitary–adrenal;MIC=minimum
inhibitoryconcentration
| CANINE PYODERMA: TOPICAl & SYSTEMIC TREATMENT
Today’s Veterinary Practice March/April 201244
Kimberly S. Coyner, DVM,
Diplomate ACVD, received
her DVM from Colorado State
University. After a private
referral practice internship and
a year practicing emergency
medicine, she completed
a 2-year teaching position
and then a 3-year residency
position in dermatology at
the University of Georgia. Dr. Coyner has authored
several book chapters in the field of dermatology—
Morgan’sHandbookofSmallAnimalPractice, 4th
edition (2002) and Small Animal Dermatology Color AtlasandTherapeuticGuide (2001 and 2006)—as
well as articles in VeterinaryDermatology,Veterinary
Medicine, and TheCompendiumonContinuing
EducationforthePracticingVeterinarian. She is
currently in private practice at the Dermatology
Clinic for Animals of Las Vegas.
Correction
Inthisseries’firstarticle,Disease Overview & Diagnosis,a
referencewasmissingfromthetext.Visittodaysveterinary
practice.comtoviewthecorrectedarticle and references.
References
1. Scott dw, miller wH, Griffin Ce. Muller and Kirk’s Small Animal Dermatology, 6th ed. Philadelphia: wB Saunders, 2001, pp 291-296.
2. white Sd. review article: Systemic treatment of bacterial skin infections of dogs and cats. Vet Derm 1996; 7:133-143.
3. aucoin d. Target: The Antimicrobial Reference Guide to Effective Treatment, 4th ed. Port Huron; north american Compendiums, inc, 2011, ii-xv.
4. Papich mG, riviere Je. Chapter 38: Fluoroquinolone antimicrobial drugs. in riviere Je, Papich mG (eds): Veterinary Pharmacology and Therapeutics, 9th ed. ames, ia: wiley-Blackwell Publishing, 2009.
5. Papich mG. Ciprofloxacin pharmacokinetics and oral absorption of generic tablets in dogs. Am J Vet Res (accepted and in press).
6. macdougall C, Powell P, Johnson C, et al. Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and
Escherichia coli in 17 US hospitals. Clin Infect Dis 2005; 41:435-440.
7. dalhoff a, Schubert S. dichotomous selection of high-level oxacillin resistance in Staphylococcus aureus by fluoroquinolones. Intl J Antimicrob Agents 2010; 36:216–221.
8. venezia ra, domaracki Be, evans am, et al. Selection of high level oxacillin resistance in heteroresistant Staphylococcus aureus by fluroquinolone exposure. J Antimicrob Chemo 2001; 48:375-381.
9. deBoer dJ, moriello Ka, Thomas CB, Schultz KT. evaluation of a commercial staphylococcal bacterin for management of idiopathic recurrent superficial pyoderma in dogs. Am J Vet Res 1990; 51(4):636-639.
10. Becker am, Janik Ta, Smith eK, et al. Propionibacterium acnes immunotherapy in chronic recurrent canine pyoderma. an adjunct to antibiotic therapy. J Vet Intern Med 1989; 3(1):26-30.
11. Curtis CF, Lamport ai, Lloyd dH. masked, controlled study to investigate the efficacy of a Staphylococcus intermedius autogenous bacterin for the control of canine idiopathic recurrent superficial pyoderma. Vet Derm 2006; 17(3):163-168.
12. Fitzgerald Jr. The Staphylococcus intermedius group of bacterial pathogens: Species re-classification, pathogenesis and the emergence of methicillin resistance. Vet Derm 2009; 20:490-495.